Abstract TMP94: Health Inequity And Time From Stroke Onset To Arrival Trends: A Single-centre Experience

Introduction: Clinical outcomes post childhood stroke have been shown to largely depend on age at the time of stroke, and the size and location of the infarct. However, the impact of health inequities on time to hospital arrival and outcomes remain inadequately addressed. This study examined trends in material deprivation and its impact on time from stroke onset to arrival in the ER for children with arterial ischemic stroke. Methods: A consecutive cohort of children >28 days-18 years of age diagnosed with arterial ischemic stroke between 2004 and 2019 at a comprehensive stroke centre were included. The Ontario Marginalization Index data for each child was derived from their residential postal code using validated mapping techniques. Within the index, material deprivation measures the income, education, single-parent families, and housing quality in a region. Patients were stratified into 3 cohorts by year of presentation; Cohort 1: 2004-2008, Cohort 2: 2009-2013, and Cohort 3: 2014-2019, while their postal codes were dichotomized into low or highly deprived neighbourhoods. The time from stroke onset to arrival was stratified into < 6 hours, 6 to 24 hours, and > 24 hours. Results: Amongst 285 children, more lived in a highly deprived neighbourhood in the later cohort (Cohort 3: 2014-2019) than the earlier cohort (Cohort 1: 2004-2008) (47.5% vs. 40.3%). Compared to Cohort 1, more patients in Cohort 3 arrived in the ER within 6 hours of stroke onset (28.3% vs 52.5%) while a similar trend was found in patients arriving 6 to 24 hours post onset of stroke (10.1% vs. 23.2%). From Cohorts 1 to 3, a significant increase in the proportion of patients arriving in the ER within 6 hours of stroke onset was found (χ 2 = 10.9, p = 0.027). Conclusion: Our study demonstrated an increasing trend toward more patients with stroke coming from highly deprived neighbourhoods. This is a cause for concern. However, whether this has an impact on stroke severity and outcomes is yet to be determined. Over the same period, more patients within the later cohort arrived in the ER within 6 hours of stroke onset. These findings may be attributed to sustained community-based education and primary-care initiatives that have led to increased awareness of childhood stroke symptoms over the past 15 years.